煤工尘肺早期辅助诊断生物标志物研究

Biomarkers for early diagnosis of pneumoconiosis in coal workers

目的探讨煤工尘肺(CWP)早期辅助诊断的生物标志物及其临床意义。方法采用立意抽样法,以69例男性煤矿粉尘作业工人为对照组,以67例男性CWP患者为CWP组。采集2组人群血清,以比色法测定其中丙二醛(MDA)及超氧化物歧化酶(SOD)水平,以酶联免疫吸附法测定白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)水平,以改良Ellman法测定乙酰胆碱酯酶(AChE)活力。采用Logistic回归模型分析CWP发病的危险因素,采用受试者工作特征(ROC)曲线分析CWP发病进程中的敏感指标。结果与对照组比较,CWP组人群血清中SOD活力下降(中位数:65.1 vs 59.2 kU/L,P<0.05),MDA、IL-6、TNF-α水平均升高(中位数:4.92 vs 6.68μmol/L,129.82 vs 163.18 ng/L,63.90 vs 70.93 ng/L,P<0.05)。Logistic回归分析结果显示,AChE是CWP的保护因素,年龄、慢性呼吸道症状、IL-6、MDA均是CWP的危险因素(P<0.05)。ROC曲线分析结果显示,IL-6和MDA均可作为煤矿粉尘作业工人CWP诊断的早期指标。结论血清中IL-6和MDA水平可作为CWP早期辅助诊断的生物标志物。

Objective To explore biomarkers for early auxiliary diagnosis of pneumoconiosis in coal workers(CWP) and its clinical significance. Methods Sixty-nine male coal miners exposed to dust were selected as control group, and sixty-seven CWP male patients were chosen as CWP group by purposive sampling method. Serum samples were collected from subjects of the two groups. The levels of malonaldehyde(MDA) and superoxide dismutase(SOD) were determined by colorimetric method. The enzyme-linked immunosorbent assay was used to measure the level of interleukin-6(IL-6) and tumor necrosis factor alpha(TNF-α). The acetylcholinesterase(AChE) activity was determined by modified Ellman method. The logistic regression model was used to analyze the risk factors of CWP. The receiver operating characteristic(ROC) curve was established to analyze the sensitive indicators in the pathogenesis of CWP. Results The serum SOD activity decreased(median: 65.1 vs 59.2 kU/L, P<0.05), and the MDA, IL-6 and TNF-α levels increased in the CWP group(median: 4.92 vs 6.68 μmol/L, 129.82 vs 163.18 ng/L, 63.90 vs 70.93 ng/L, P<0.05) compared with the control group. The logistic regression analysis results showed that AChE was the protective factor of CWP, while age, chronic respiratory symptoms, IL-6 and MDA were the risk factors of CWP(P<0.05). The ROC curve showed that IL-6 and MDA can be used as early indicators for the diagnosis of CWP in dust-exposed workers. Conclusion The serum IL-6 and MDA levels can be used as biomarkers for early auxiliary diagnosis of CWP.